Fibromyalgia: Leavitt F

Leavitt F, Katz RS. · Rush Medical College, Chicago, Illinois, USA. · Arthritis Rheum. · Pubmed #19479690 No free full text.

Abstract: OBJECTIVE: To examine the impact of distraction on the retention of rehearsed information in patients with fibromyalgia syndrome (FMS). METHODS: Data refer to the neurocognitive examination of 134 patients (91 with FMS and 43 control subjects) presenting with memory loss. Four neurocognitive measures free of distraction, along with 2 measures with added distraction, were completed. Differences in the retention of rehearsed and unrehearsed information with a source of distraction present were calculated. RESULTS: Patients with FMS showed normal cognitive functioning on verbal memory tests free of distraction. Adding a source of distraction caused unrefreshed information to be lost at a disproportionate rate in patients with FMS. Over 87% of patients with FMS scored in the impaired range on a task of unrehearsed verbal memory. Adding a source of distraction to well-rehearsed information produced a normal rate of recall in FMS. CONCLUSION: Rehearsal mechanisms are intact in patients with FMS and play beneficial roles in managing interference from a source of distraction. In the absence of rehearsal, a source of distraction added to unrefreshed information signals a remarkable level of cognitive deficit in FMS that goes undetected by conventionally relied-upon neurocognitive measures. We present a theory to promote understanding of the cognitive deficit of people with FMS based on reduced speed of lexical activation and poor recall after distraction.

Leavitt F, Katz RS. · Department of Behavioral Sciences, Section of Rheumatology, Rush Medical College, Chicago, IL, USA. · J Clin Rheumatol. · Pubmed #18636019 No free full text.

Abstract: OBJECTIVE: Abnormal processing of information in fibromyalgia may hold clues to brain abnormalities in this illness. The purpose of this study is to examine the speed of mental operations in people with the fibromyalgia syndrome (FMS) under the pressure of time. The central question addresses whether FMS is associated with processing speed deficits across a spectrum of speeded tasks. METHODS: Sixty-seven patients with fibromyalgia with a history of memory complaints and 51 controls presenting with complaints of memory loss completed 10 timed cognitive measures of processing speed. Controls were patients with memory complaints who did not have FMS. RESULTS: The majority of FMS patients (>70%) performed within 1 standard deviation of the norm on 7 or more of 10 speeded measures. However, more than 49% of FMS patients tested as impaired (>1.67 SD below normative mean) on 2 specific validated speed tasks (reading words and naming colors). Compared with controls, the number of FMS patients showing impairment was 2.0 times greater for reading speed, and 1.6 times greater for color naming speed. A mean time delay of 203 milliseconds was recorded for reading words and 285 milliseconds for naming colors in the FMS impaired sample. A 203 milliseconds delay in reading words represents a 48% (203/417) time increase over the normal time for reading the same stimulus word. CONCLUSION: Abnormalities in naming speed are an unappreciated feature of FMS. Selective deficits in naming speed in association with otherwise well preserved global processing speed set patients with FMS apart from controls with memory complaints. Clinicians would be wise to specifically request adding a rapid naming test such as the Stroop Test to the cognitive battery; to document cognitive dysfunction in FMS patients who otherwise appear to test normally, despite often intense complaints of memory and concentration difficulties that can affect job performance and increase disability.

Leavitt F, Katz RS, Mills M, Heard AR. · Department of Psychology, Rush Medical College, 1653 West Congress Parkway, Chicago, IL 60612, USA. · J Clin Rheumatol. · Pubmed #17041327 No free full text.

Abstract: Memory decline and mental confusion frequently complicate the clinical presentation of fibromyalgia; however, formal cognitive examination often does not support deterioration. This paradox was examined in the context of dissociation, a condition with many cognitive similarities. Dissociation refers to the separation of parts of experience from the mainstream of consciousness. A common example is highway hypnosis. Eighty-nine fibromyalgia (FM) patients and 64 other rheumatic disease patients were screened for memory decline and mental confusion using a questionnaire format. Pain, dissociation, affective distress, fatigue, sleep difficulty, and mental confusion were also assessed. Cognitive complaints (76.4%-43.8%) and dissociative symptoms (37.1%-1.9%) were overrepresented in patients with FM. Among FM patients with high dissociation, cognitive difficulties were reported by 95%; 100% of these cases reported that both memory and mental clarity were affected, a condition referred to as fibrofog. Dissociation in combination with fibrofog was associated with higher levels of FM symptom intensity and decreased mental well being. These findings suggest that dissociation may play a role in FM symptom amplification and may aid in comprehending the regularity of cognitive symptoms. Separating cases of fibrofog from cognitive conditions with actual brain damage is important. It may be prudent to add a test of dissociation as an adjunct to the evaluation of FM patients in cases of suspected fibrofog. Otherwise, test results may prove normal even in patients with disabling cognitive symptoms.

Leavitt F, Katz RS. · Department of Psychology, Rush Medical College, Chicago, Illinois 60612-3833, USA. · J Rheumatol. · Pubmed #16395760 No free full text.

Abstract: OBJECTIVE: Patients with fibromyalgia (FM) frequently complain of poor memory, severe enough to affect job performance and to lead to disability. Yet common practices in neurocognitive examinations often fail to document cognitive abnormalities that match the severity of their memory complaints. Often, neuropsychologists gauge memory competence with measures free of distraction and produce high rates of normality on neurocognitive examination. We hypothesized that neurocognitive tests encoded with a source of stimulus competition that interferes with the processing and/or absorption of information would be better than others in gauging FM memory competence. METHODS: Thirty-five patients with FM and 35 controls, matched for age and sex, and presenting with complaints of memory loss, completed cognitive measures with and without stimulus competition. RESULTS: Eleven (31.4%) patients with FM showed impairment on at least one measure of memory encoded free of stimulus competition. By comparison, 30 (85.7%) showed impairment on at least one measure encoded with a source of stimulus competition. The Auditory Consonant Trigram detected impairment in 29 (82.6%) cases, and was by far the most sensitive measure. FM patients lost information at a 58% rate following a 9 second distraction. This loss was disproportionate to the loss shown by both age matched controls with memory problems (40%) and to normative values (20%) based on individuals free of memory problems. CONCLUSION: The findings validate the perception of failing memory in patients with FM and are the first psychometric based evidence to our knowledge of short-term memory problems in FM linked to interference from a source of distraction. Adding a source of distraction caused the majority of FM patients to retain new information poorly, and may be integral to an understanding of FM memory problems. Much needs to be learned about why new information is disproportionately lost by FM populations when a source of distraction enters the experiential field.